The URL can be used to link to this page

Home My WebLink About7876-z FO/~I~ NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7876 Z Permission is hereby granted to: .............. ?.tv.~...~ ~..e..n..e....;~! ~!~ ........................ .......................... B~¥~ide ................................... Fo ..~e~...f~.~(~.~n~--.a.s..:~.o~'..-a~,,,l~a~-%o~ ............................................................................ at premises located at ..~g'~..J~e.v. e2~.y...l~o~cl...~.t...,q~L~...(....~i,~J~..,~.~Cf..~ .............................. ....................................................... Sau.th~td ...................................................................................... pursuant to application dated .......................... ~:~,~'. ...... ~ ............ , 19...~..~., and approved by the Building Inspector. Fee $.:~.~[ ,D.Q ........... FORm NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined '/~/~ (~'~t ;~ 19.~..~7 Application No .... .7.~...2.[~. ............. Approved ..................... [ .......... .~......, 19...?.,~~ Permit No..?..E..~...~......~ ........ Disapproved a/c .............................................................. APPLICATION FOR BUILDING PERMIT Oate .............. ........ , 9. .7.. /;. . .'n INSTRUCTIONS a This apphcation must be completely filled m by typewnter or in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing location of lot and of buildmgs on premises, relabonship to adlo~nmg premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s part of this applicabon. c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will ~ssue a Buildmg Permit to the apphcant. Such permit shall be kept on the premises available for mspection throughout the work. e No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the BuHdmg Zone Ordnance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordnances or Regulations, for the construction of buildings, addit.ons or alterations, or for removal or demolition, as hereto described The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized mspectors on premises and in buildings for necessary inspections. x ..... .¢..~ ~ ...... .~./...4~ ..z:~... ....................................... (Signature of applicant, or name, Jfa corporation) (Address of c~li~ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ................................................................................................................................................. Name of owner of premises ...... ...,¢¢~.....~...5.. ....... .?..~...~..,?.~...~'.......,~...-~.../-:..~-..47<.. ...................................................................... If apphcant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... 1. Locatmn of land on which proposed work will be done. Map No ........ .~.' ................... Lot No.~ ...................... Street ond Number .......... ...~....~..~.;~....~.~?.:......'~...~...* ................................. Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Exlslting use and occupancy ................................................................... b Intended use and occupancy .......... ./~..~. / 3. Nature of work (check which apphcab~e) New Budding ................. Addition ............. Alteration ........... Repair ................Removal ................ Demoht~or. ............... Other Work ....... .~.~. 4:~"..m..~ ............. (Description) 4. Estimated Cost ...................................................... Fee ...,/.~....~ (to be pa~d on filing this apphcat~on) 5. If dwelling, number of dwelling umts ............. .(_~ ...... Number of dwelhng umts on each floor If g<~rage, number of cars ........................... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7 Dimensions of existing structures, if any' Front ....................... Rear ................................ Depth .............. Height ........................ Number of Stones ...................................................................................................... D~mens~ons of same structure with olterat~ons or additions' Front ....................................Rear ..................... Depth .............................. Height .....................Number of Stones ............................ 8. D~mensions of entire new construction' Front ............... , ................ Rear ............................ Depth .................... Height .................Number of Stones ............................................................................................ 9 S,ze of lot: Front ..................?..~..'[.. ............................. Rear ......~....S:.~. .......................... Depth ..../...~..0.....~i .................. 10. Date of Purchase ................................................ Name of Former Owner .... ~.-~..~...~/..f:~...~......~...~...~..~ ............ 1 1. Zone or use district m which premises are situated ........ .'q°...~K.~...~...~4~.~...z: .................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation .............. WZ.~ ................................... 13 Will lot be regraded ............................ Will excess fill be removed from premises: ( ) Yes (,~) No 14 Name of Owner of premises .................................................... Address ................................ Phone No ...................... Name of Architect .......................................... Address ................................ Phone No Name of Contractor ................................... Address ................................ Phone No ...................... PLOT DIAGRAM Locate clearly and d~stmctly all buddings, whether ex~st~ng or proposed, and red,cate all set-back d~mens~ons fron property hnes Gwe street and block number or description according to deed, and show street names and ind~cat.~ whether interior or corner lot ~/~-',.m~>' ~0 · -o" ' COUNTY OF · .cA'~c. ~ ......... [ ' ....... .../. ........................ ,f'~ I.~ ~- ~.//---/---/-~/~' ................................... being duly sworn, deposes and says that he ~s the apphcor (Nome of md~wdual signing contract) above named He ,s the ....... ~.~.~.~ ............................................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ,s duly authorized to perform or have performed the said work and to make and fd th~s apphcat~on, that all statements contained ~n th~s apphcahon are true to the best of his knowledge and belief; an that the work wall be performed ,n the manner set fo~h ~n the apphcation filed therewith. Sworn to before me th~s ............ ~.. day of~ ,~~ ............ , 19~ ~ /~, ',.~ o uU,c,. ....... .......... co.. .............. ..... ......................... ~., ~ ,.. z~ ~ ~ (Signature of applicant) / I /~ JOSEPH M. &~DEL ( } ~ I N~Y PUBLIC, State of N~ York